Universal coverage keeps cost down in Germany

A not-for-profit, government-regulated health care system that covers 90 percent of the population; a mandate that all citizens buy insurance, with costs jointly borne by employers and employees; insured people free to choose from among dozens of competing insurers, via an exchange – sound familiar?

That’s the German system, and its similarities to Minnesota health care as it is evolving under the federal Affordable Care Act have been a magnet for policymakers on both sides of the Atlantic. This is the fourth summer in which a delegation from Minnesota’s legislative and executive branches of government, as well as a handful of business leaders and health policy professionals, travelled to Berlin as guests of the German government and of the University of Minnesota Center for German and European Studies to learn about German health care. A German delegation will come to Minnesota in exchange in November.

The German system produces enviable outcomes, yet costs about one-third less than Minnesotans spend on health care, 10 members of Minnesota’s delegation reported at a debriefing Monday night. They found many reasons for that country’s lower costs: Physician compensation is lower. Hospital rooms are never private. New drugs are rejected if a panel of experts deems their benefits insufficient to justify their cost. People exercise more and eat less.

A big thing is the German understanding that health insurance is for everyone. “They see that as an overall benefit for the entire country. It goes to their workforce’s ability to be competitive,” said DFL state Rep. Joe Atkins of Inver Grove Heights.

Assured coverage means better access to care that prevents illness or keeps them from becoming chronic and expensive, added state Sen. Tony Lourey, DFL-Kerrick. “They have better outcomes, and that’s because they really use their health care system. They have access to health care while they are healthy. With our rate of uninsured, people wait until they are very, very ill, and their conditions have advanced to the point that they are very expensive to treat. That’s where a lot of our dollars go.”

It’s reassuring to know that Germans find something to admire about Minnesota health care too. They want to learn about this state’s approach to long-term care and its use of non-physician health care professionals to keep costs down, the delegation said.

Lori Sturdevant, an editorial writer and columnist, has covered state government and politics for more than 30 years.